Utility of distinctive local electrogram pattern and aortographic anatomical position in catheter manipulation at
Takeshi Sasaki1, Hitoshi Hachiya, Kenzo Hirao
1Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan. tsasaki1@jhu.edu
Insights
Understanding the distinct electrical signals and anatomical locations of coronary cusps is crucial for safer radiofrequency catheter ablation. This study maps these electrograms to specific cusp positions, improving arrhythmia treatment.
Area of Science:
- Cardiology
- Electrophysiology
- Anatomy
Background:
- Coronary cusps are increasingly targeted for radiofrequency catheter ablation of ventricular and atrial arrhythmias.
- Systematic description of the relationship between local electrograms and anatomical positions of coronary cusps is lacking.
Purpose of the Study:
- To systematically describe the relationship between local electrograms recorded at each coronary cusp during sinus rhythm and their anatomical positions.
- To correlate electrogram characteristics with specific coronary cusp locations for improved ablation strategies.
Main Methods:
- Measurement of atrial and ventricular potential amplitudes at coronary cusps in 28 patients undergoing RFCA.
- Computation of the atrial/ventricular (A/V) potential ratio during sinus rhythm.
- Assessment of coronary cusp anatomical positions using aortography in two X-ray projections.
Main Results:
- Right and left coronary cusps showed higher ventricular than atrial potentials (A/V ratio <1).
- The noncoronary cusp demonstrated higher atrial than ventricular potentials (A/V ratio >1).
- Aortography confirmed distinct anatomical locations: RCC (rightward, anterior), LCC (leftward, superior), NCC (inferior, posterior).
Conclusions:
- Distinct local electrogram patterns correlate with specific coronary cusp anatomy.
- Awareness of these electrogram-cusp relationships and aortographic positions can enhance safety and efficacy of catheter ablation procedures at the coronary cusps.
Background:
The coronary cusps have recently become target sites for radiofrequency catheter ablation of both outflow tract ventricular arrhythmias originating near the coronary cusps (CC-VA) and atrial tachyarrhythmias such as focal atrial tachycardia originating near the noncoronary cusp (NCC-AT). However, the relation between local electrograms recorded at each CC during sinus rhythm and their anatomical position as assessed by aortography has not yet been systematically described.
Methods And Results:
In 28 patients undergoing RFCA for CC-VA or NCC-AT, amplitudes of the atrial and ventricular potentials at the CCs were measured during sinus rhythm, and the atrial/ventricular (A/V) potential ratio was computed. Relative positions of the CCs were assessed by aortography in 2 X-ray projections. In the right (RCC) and left coronary cusps (LCC), amplitudes of the ventricular potential were larger than those of the atrial potential, leading to an A/V ratio <1 in all patients (0.08 ± 0.10, 0.32 ± 0.21, respectively). In contrast, in the NCC, the amplitude of the atrial potential was larger than the ventricular potential, leading to a higher A/V ratio relative to the CCs (5.7 ± 2.6, P < 0.0001). Aortography demonstrated the rightward and anterior location of the RCC, the leftward and superior location of the LCC, and the inferior and posterior location of the NCC.
Conclusions:
Awareness of the distinctive local electrogram pattern of each CC and their positions on aortography should lead to safer and more effective catheter ablation at the CCs.
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